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enDatapalooza! Rhode Island releases final OE5 data w/CSR Silver Load/Switch breakout!http://acasignups.net/18/03/19/datapalooza-rhode-island-releases-final-oe5-data-wcsr-silver-loadswitch-breakout
<span class="submitted-by">Mon, 03/19/2018 - 9:28am</span><div class="field field-name-field-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="http://acasignups.net/sites/default/files/styles/400x400/public/rhode_island_grey_5.png?itok=bNbC8pas" width="300" height="300" alt="" /></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p>HealthSource RI, Rhode Island's ACA exchange, released preliminary 2018 Open Enrollment data awhile ago, but this morning they released their final, official demographic data breakout, and <a href="https://mailchi.mp/498a31a67702/hsri-sees-5-enrollment-increase-and-nation-leading-lowest-benchmark-plan-cost?e=baaff4093c">there's a lot going on here:</a></p>
<blockquote><p><strong>HealthSource RI sees 5% enrollment increase and nation leading lowest benchmark plan cost<br />
State-based marketplace sees rise in enrollment of “young invincibles”</strong></p>
<ul><li>In Rhode Island, individual and family paid enrollments increased by five percent in 2018, among the largest increases in the country.</li>
</ul><ul><li>The marketplace saw<strong> over 8,000 new enrollees</strong>, over <strong>40 percent more than the previous year</strong>. <strong>About 35 percent of new 2018 customers were “young invincibles” age 18-34, up from approximately 25 percent compared to HealthSource RI’s 2017 population.</strong></li>
</ul><ul><li>HealthSource RI’s competitive marketplace offers the <strong>lowest cost benchmark plan nationwide</strong> in 2018.</li>
</ul><ul><li>The amount of <strong>financial assistance</strong> brought into Rhode Island to make health coverage more affordable<strong> increased by 46 percent, to $7.4 million</strong>, in January 2018, compared to January 2017.</li>
</ul><ul><li>The <strong>average subsidized customer </strong>saw <strong>steady rates in 2018</strong> due to the <strong>protective effect of their subsidies rising to offset premium increases.</strong></li>
</ul><ul><li>HealthSource RI’s targeted customer education and new Savings Tool helped shoppers make wise decisions in 2018, leveraging their increased financial assistance and <strong>opting for Gold plans in many cases.</strong></li>
</ul><p>EAST PROVIDENCE, R.I. (March 19, 2018) — HealthSource RI today announced a <strong>5 percent increase in individual and family customers</strong> at the end of the 2018 Open Enrollment period. <strong>As of January 31, 2018, 30,637 individuals enrolled and paid for 2018 health coverage</strong> through HealthSource RI, compared to <strong>29,224 in 2017</strong>.</p>
</blockquote>
<p>It's important to note the <strong>"and paid for</strong>" caveat here for both years, and it's really interesting:</p>
<ul><li>For 2017, Rhode Island's Open Enrollment Period ran the full 3 months, through Jan. 31st. They had a total of <a href="http://acasignups.net/states-2018-vs-2017">29,456 QHP selections</a>, of which 29,224 actually paid their first monthly premium...or 99%.</li>
<li>For 2018, Rhode Island's Open Enrollment Period cut off at 2 months, through Dec. 31st. They had a total of <a href="http://acasignups.net/18/01/03/rhode-island-semi-final-2018-total-33000-qhps-blows-away-last-year">33,021 QHP selections</a>, of which 30,637 actually paid their first monthly premium...or about 93%.</li>
</ul><p>In other words, while they outperformed 2017 by over 12% in initial enrollments, they're only 5% ahead of 2017 in actual paid/effectuated enrollees. It remains to be seen whether this is reflected nationally; keep in mind that Rhode Island is one of the smallest states (and therefore, has one of the smallest exchange populations).</p>
<blockquote><p>HealthSource RI saw a <strong>45 percent increase in new customers</strong> to the state-based marketplace this year, up from 5,543 individuals in 2017 to 8,038 in 2018. About <strong>35 percent of new 2018 customers were “young invincibles” age 18-34, up from approximately 25 percent</strong> compared to HealthSource RI’s 2017 population.</p>
<p>“Young invincibles are <strong>good for the overall stability of the market </strong>as they are typically healthier and therefore utilize less medical services,” said HealthSource RI Director Zachary W. Sherman. “I am encouraged we saw a big jump in overall new customers this year and that so many younger Rhode Islanders decided to enroll in high-quality, affordable HealthSource RI coverage for the first time.”</p>
</blockquote>
<p>That's <strong>huge</strong>. Keep in mind that <a href="http://www.modernhealthcare.com/article/20160514/magazine/305149980">most actuaries felt that the ACA exchanges would need around 40%</a> of the enrollees to be in the 18-34 range for the market to be truly stable, so Rhode Island is still a bit below that, but it's still an impressive improvement. Nationally, the ACA exchanges have averaged around 28% Young Invincibles year over year, although that doesn't include the off-exchange market, where the age brackets may be different.</p>
<blockquote><p><strong>Rhode Islanders younger than 45 years old make up about half of 2018 customers,</strong> as shown in Figure 2. Enrollment by gender remains fairly consistent in 2018. As of January 31, the gender breakdown was <strong>54 percent (16,513 individuals) female and 46 percent (14,124 individuals) male.</strong></p>
</blockquote>
<p class="rtecenter"><a class="colorbox colorbox-insert-image" href="http://acasignups.net/sites/default/files/styles/inline_default/public/ri_oe5_age_breakout.png?itok=pCzbSV2x"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/ri_oe5_age_breakout.png?itok=pCzbSV2x" /></a></p>
<p>They include the all-too-rare carrier market share breakout...</p>
<blockquote><p>There was a notable shift in plan enrollment<strong> towards Neighborhood Health Plan of Rhode Island</strong> (NHPRI), with<strong> market share rising from about 50 percent in 2017 to 70 percent </strong>(21,525 individuals) this year. This trend was <strong>most pronounced in new customers</strong>, who chose NHPRI over 80 percent of the time. The other 30 percent (9,112 individuals) of 2018 HealthSource RI customers enrolled in health coverage from Blue Cross &amp; Blue Shield of Rhode Island (BCBSRI). <strong>The shift was primarily driven by NHPRI’s lower prices.</strong></p>
</blockquote>
<p>...and then get into one of the most important factors for 2018: The impact of CSR Silver Loading/Silver Switching on enrollment. Rhode Island was one of about 20 states which <a href="https://docs.google.com/spreadsheets/d/1W2EQhCXowRDDuqJhy6PUJtIGHjoND9f_K7oALyDAbLg/edit#gid=0">went the full "Silver Switcharoo" route</a>, so let's see how much of an impact that made:</p>
<blockquote><p><strong>In response to the federal administration’s decision to end Cost Sharing Reduction (CSR) payments</strong> to insurers, BCBSRI and NHPRI were asked to <strong>focus their premium rate increases on Silver-level plans sold on HealthSource RI’s individual market.</strong> Because the cost of these plans determines the dollar amount of federal tax credits relative to consumers’ income, the <strong>premium rate increases on these plans were absorbed by the tax credit </strong>for most customers. Due to HealthSource RI and the Office of the Health Insurance Commissioner’s <strong>protective state-based actions</strong>, considerably more federal financial assistance will be provided to Rhode Island marketplace customers. <strong>In January 2018, $7.5 million in financial assistance was provided</strong> to HealthSource RI customers to make their premiums more affordable, <strong>compared to $5.1 million in January 2017, a 46 percent increase.</strong></p>
<p><strong>“The Affordable Care Act is working in Rhode Island.</strong> Nearly every person in the state now has health insurance, and the <strong>premiums on HealthSource RI are among the lowest in the country,</strong>” said Governor Gina M. Raimondo. “Washington’s recent actions will undermine our great progress, putting us at risk of unnecessary price increases, instability and fewer plan choices. It is our responsibility to look for ways for the state to protect against federal threats to coverage and affordability.”</p>
<p>Despite increases in Silver plan premiums, HealthSource RI has the lowest benchmark plan nationwide in 2018. The benchmark plan is the second-lowest cost Silver plan available, and determines the amount of financial assistance customers receive. However,<strong> the phenomena of many Silver plans costing more than Gold led to a shift in 2018 enrollment by metal levels</strong> (Figure 3). HealthSource RI saw a <strong>significant reduction in unsubsidized Silver customers</strong>, as well as a <strong>drop in Silver customers who only receive tax credits</strong>. <strong>Ninety-two percent of unsubsidized 2017 Silver-level customers</strong>, who actively selected a 2018 plan, <strong>chose a different metal level this year</strong>. Most CSR eligible customers stayed in Silver plans since their tax credit absorbed most of the premium increase. Most significantly, <strong><span style="background-color:#ffff00">22 percent of HealthSource RI customers selected a Gold plan for 2018, up from 12 percent in 2017.</span></strong></p>
</blockquote>
<p class="rtecenter"><a class="colorbox colorbox-insert-image" href="http://acasignups.net/sites/default/files/styles/inline_default/public/ri_oe5_metal_level.jpg?itok=vGR5zSwK"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/ri_oe5_metal_level.jpg?itok=vGR5zSwK" /></a></p>
<p>The bar graph above is very important in terms of understanding how much Silver Loading impacted the enrollment trends. Assuming no other significant contributing factors, Silver Loading resulted in...</p>
<ul><li>a 2.5 percentage point shift towards Bronze plans</li>
<li>a 9.9 percentage point shift towards Gold plans</li>
<li>Silver 87% &amp; 94% stayed almost identical (which makes sense since they're both effectively the same as a Gold plan anyway, <strong>however</strong>...</li>
<li>Silver 73% saw a full 3.5 point drop</li>
<li>Overall, Silver saw a full 12.3 point drop</li>
</ul><p>Why is this important? Because <strong>funding CSRs *at this point* would end up HURTING</strong> more Rhode Islanders than it would help.</p>
<p>Subsidized enrollees in Gold or Bronze plans this year--<strong><span style="background-color:#ffff00">around 28.5% of all enrollees--would see their premiums increase in 2019 if CSRs were restored</span></strong>, while I believe only unsubsidized enrollees who chose Silver (2.2% of the total), plus some number of off-exchange enrollees (numbers unknown) would be helped by it. Since Rhode Island limited CSR loading to <strong>on-exchange</strong> Silver plans, in theory most off-exchange enrollees shouldn't be impacted one way or the other.</p>
<p><a href="http://acasignups.net/17/08/29/major-correction-individual-market-has-dropped-119-or-102-2016">According to Mark Farrah Associates</a>, in March 2017, Rhode Island's off-exchange individual market totalled around 13,800 people...but that includes some number of "grandfathered" enrollees (Rhode Island didn't allow "transitional" plans). Assuming perhaps 1,800 of these folks are in grandfathered plans, that's around 11,000 in off-exchange ACA-compliant policies. How many of these folks are in Silver plans? I have no idea, but again, the vast majority of off-exchange enrollees shouldn't be impacted by CSR funding in Rhode Island regardless.</p>
<blockquote><p>To mitigate customer confusion and ensure customers picked the best plan for them, HealthSource RI introduced a new Savings Tool to make it easier to understand health coverage options. This quick quote tool helped Rhode Islanders consider their total health needs, from premium price and financial assistance to maximum out-of-pocket cost and provider networks. During Open Enrollment, over 60,000 sessions from more than 40,000 unique users took place on the Savings Tool. HealthSource RI also rolled-out aseries of educational videos aimed to simplify the decision making process.</p>
</blockquote>
<p>The exchange also underscores another important point which is often lost in the shuffle:</p>
<blockquote><p>“In a year of uncertainty, <strong>state-based marketplaces like HealthSource RI saw higher enrollment and retention than HealthCare.Gov states</strong> due to our ability to<strong> nimbly adapt and serve our local communities,</strong>” Sherman added. “By enabling and educating our customers,<strong> many made the informed decision to leverage their increased purchasing power</strong> which led to higher enrollment in richer benefit plans at no additional cost.”</p>
<p><strong>Eighty-two percent of HealthSource RI customers received financial assistance</strong> in 2018, which is essentially unchanged from 2017. Of those receiving financial help, <strong>50 percent (15,349 individuals) received both tax credits and CSRs and 32 percent (9,810 individuals) received only tax credits,</strong> while the remaining 18 percent (5,478 individuals) did not receive financial help.</p>
<p>Though Open Enrollment for 2018 health coverage has ended, HealthSource RI may be able to offer a Special Enrollment Period to individuals and families who go through life changes that affect their ability to get healthcare coverage. Those who experience a qualifying life event, like moving to Rhode Island or losing employer sponsored coverage, should contact HealthSource RI at 1-855-840-4774 or in-person at 401 Wampanoag Trail in East Providence. <a href="http://www.HealthSourceRI.com/individuals-and-families/sep">Full list of qualifying events and hours of operation</a>.</p>
<p>Small employers who purchase coverage through HealthSource RI for Employers may enroll in health insurance coverage throughout the year at their regular renewal date.</p>
</blockquote>
</div></div></div><div class="field field-name-field-tags field-type-taxonomy-term-reference field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/tags/rhode-island">Rhode Island</a></div><div class="field-item odd"><a href="/tags/oe5">OE5</a></div><div class="field-item even"><a href="/tags/datapalooza">Datapalooza</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1">
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</ul>Mon, 19 Mar 2018 13:28:25 +0000Charles Gaba4913 at http://acasignups.nethttp://acasignups.net/18/03/19/datapalooza-rhode-island-releases-final-oe5-data-wcsr-silver-loadswitch-breakout#commentsFamilies USA agrees: Restoring CSRs *NOW* would hurt millions of low-income peoplehttp://acasignups.net/18/03/16/families-usa-agrees-restoring-csrs-now-would-hurt-millions-low-income-people
<span class="submitted-by">Fri, 03/16/2018 - 2:45pm</span><div class="field field-name-field-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="http://acasignups.net/sites/default/files/styles/400x400/public/families_usa_0.jpg?itok=d5Ym7PJz" width="180" height="180" alt="" /></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p><a href="http://familiesusa.org/product/under-guise-“health-insurance-stabilization”-congress-should-not-axe-financial-help-low-wage">This is exactly what Dave Anderson, Colin Ballio and I have been talking about for awhile now:</a></p>
<blockquote><p><strong>Under the Guise of “Health Insurance Stabilization,” Congress Should Not Axe Financial Help for Low-Wage Families</strong></p>
<p>In negotiations over stabilizing the individual health insurance market, lawmakers are considering slashing federal health care assistance for low- and moderate-income consumers by more than $27 billion a year. In dollars terms, this would be a greater blow than completely eliminating, in one stroke, the Low-Income Home Energy Assistance Program, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), the Child Care and Development Block Grant, the Community Development Block Grant, and federal grant programs for community-based mental health services and substance abuse prevention and treatment.</p>
<p><strong>Families USA strongly supports the goal of stabilizing the individual market and lowering premiums</strong> paid by consumers whose incomes are too high to qualify for federal premium tax credits (PTCs). However, elements of the stabilization proposals under discussion are quite troubling. <strong>No stabilization package should rob low- and moderate-income households of the help they currently receive</strong> paying for health insurance unless that same package leaves them whole by fully compensating them for the major losses they would otherwise experience.</p>
<p><strong>One part of the stabilization package would cut $27 billion a year from the tax credits on which low- and moderate-income families rely in buying insurance</strong></p>
<p>Members of Congress are seriously considering restoring federal payments that cover health insurers’ costs of furnishing legally required cost-sharing reductions (CSRs) to low- and moderate-income consumers. <strong>If Congress takes this step, more than 2 million consumers could see their out-of-pocket insurance costs double, triple, or even increase seven-fold.</strong></p>
</blockquote>
<p>The "more than 2 million" figure is much lower than the <a href="http://acasignups.net/18/03/16/ball-confusion-dems-may-have-two-more-factors-consider-re-omnibus-bill">4.5 million I spitball-estimated the other day</a>, but in <a href="http://familiesusa.org/sites/default/files/product_documents/MCD_Dont_Fund_CSRs_Factsheet.pdf">the actual report itself,</a> Families USA clarifies that:</p>
<blockquote><p>The table <strong>greatly understates the number of adversely affected consumers</strong>, for several reasons: <strong>Many more PTC beneficiaries enrolled in non-silver plans for 2018</strong> than for 2017.<strong> The 2018 boost to PTC amounts greatly cut these consumers’ premium costs for non-silver plans</strong>, the premiums of which were unaffected by CSR non-payment. <strong>In California</strong>, for example, the proportion of PTC beneficiaries enrolled in bronze, gold, or platinum plans rose from <strong>31 percent in 2017 to 50 percent in 2018</strong>—a 60 percent relative increase. <strong>If comparable increases were experienced in all states with results shown below</strong>, the estimated total number of severely harmed consumers <strong>would rise from 2.0 million to 3.2 million.</strong></p>
</blockquote>
<p>This is still far lower than the 4.5 million I estimated...but truth be told, there's no way of knowing what the national total would because <a href="http://acasignups.net/18/03/15/no-official-oe5-cms-data-hasnt-been-released-yet-yes-clock-ticking">CMS STILL HASN'T RELEASED THE 2018 ASPE REPORT OR PUBLIC USE FILES YET</a>. This is the longest they've ever gone without doing so, and there's no excuse whatsoever, especially since 41 states wrapped up the 2018 Open Enrollment Period <strong>way back on December 15th.</strong></p>
<p>In any event, Families USA uses a very rough estimate of how much premium tax credit assistance of $27 billion per year based on CBO estimates:</p>
<blockquote><p><strong>At this juncture, restoring CSR payments to plans would slash tax credits for low- and moderate-income consumers by a surprisingly large amount.</strong> According to the nonpartisan Congressional Budget Office (CBO), paying insurers for CSRs would cut federal health coverage assistance by $247 billion from 2018-2026, <strong>averaging $27.3 billion a year*. This is far more than the $20.1 billion combined annual impact of completely eliminating all of the following programs</strong></p>
<ul><li>The Low-Income Health Energy Assistance Program (LIHEAP), which pays heating costs for 6 million low- and moderate-income households;</li>
<li>WIC, which feeds more than 7 million poor and near-poor pregnant women and infants;</li>
<li>The Child Care and Development Block Grant (CCDBG), which provides child care for 1.4 million children;</li>
<li>The Community Development Block Grant (CDBG), which helps 1,209 localities and all 50 states develop affordable housing and employment opportunities, mostly to benefit low- and moderate-income residents; and</li>
<li>The Community Mental Health Services Block Grant (MHBG), which provides mental health treatment to 7.4 million people;</li>
<li>The Substance Abuse Prevention and Treatment Block Grant (SABG), which helps 1.6 million people who struggle with substance use disorders.</li>
</ul></blockquote>
<p>They go on to explain a bit about how restoring CSR funding would <strong>help</strong> unsubsidized enrollees but <strong>hurt</strong> subsidized enrollees at the same time:</p>
<blockquote><p>Supporters of this proposal argue that restoring CSR payments would lower premiums. <strong>That claim is misleading, even though unsubsidized silver premiums would rise more slowly</strong> than projected if CSR payments were restored. <strong>The vast majority of consumers enrolled in silver plans are tax credit beneficiaries,</strong> who do not pay the full premium. <strong>Their out-of-pocket premium costs would skyrocket if Congress pays insurers for CSRs.</strong></p>
</blockquote>
<p>To my surprise, they even link directly to the <a href="http://docs.google.com/spreadsheets/d/1W2EQhCXowRDDuqJhy6PUJtIGHjoND9f_K7oALyDAbLg/edit#gid=0">CSR Silver Load/Silver Switch spreadsheet</a> set up by myself, Dave Anderson, Louise Norris and Andrew Sprung last fall ("20 states")!</p>
<blockquote><p>Moreover, if Congress leaves current arrangements in place, states can shield unsubsidized consumers from harm by limiting CSR-related premium increases to marketplace silver plans and encouraging unsubsidized consumers to move to off-marketplace silver plans. <a href="https://docs.google.com/spreadsheets/d/1W2EQhCXowRDDuqJhy6PUJtIGHjoND9f_K7oALyDAbLg/edit#gid=0">20 states</a> have already taken this step. In addition, premiums would shoot up for unsubsidized consumers in gold plans if insurers’ CSR payments are restored, according to CBO.</p>
</blockquote>
<p><a href="http://acasignups.net/18/03/16/ball-confusion-dems-may-have-two-more-factors-consider-re-omnibus-bill">As I noted the other day</a>, the waters could be a bit muddier than Families USA describes it, if only because there's a possibility that CMS could potentially be able to prevent silver loading from happening next year at all...but assuming that's<strong> not</strong> the case, their point stands: The economics of appropriating CSR funding almost completely flipped around six months ago, to the point that <strong>it would likely end up harming more people than it helps without other mitigating factors included.</strong></p>
</div></div></div><div class="field field-name-field-tags field-type-taxonomy-term-reference field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/tags/csrs">CSRs</a></div><div class="field-item odd"><a href="/tags/omnibus">Omnibus</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_2">
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</ul>Fri, 16 Mar 2018 18:45:26 +0000Charles Gaba4911 at http://acasignups.nethttp://acasignups.net/18/03/16/families-usa-agrees-restoring-csrs-now-would-hurt-millions-low-income-people#commentsRevenge of the Rubio-Con: Marco Rubio's Risk Corridor Massacre could cost taxpayers up to $12.3 billionhttp://acasignups.net/18/03/16/revenge-rubio-con-marco-rubios-risk-corridor-massacre-could-cost-taxpayers-123-billion
<span class="submitted-by">Fri, 03/16/2018 - 10:52am</span><div class="field field-name-field-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="http://acasignups.net/sites/default/files/styles/400x400/public/rubicon.jpg?itok=UUpiSJ5x" width="300" height="200" alt="" /></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p><a href="http://acasignups.net/16/08/31/return-rubi-con-marco-rubio-killed-jobs-helped-force-800k-people-policies-may-cost">OK, first take a few minutes to read all of this.</a></p>
<p>I'll wait.</p>
<p>OK, done? Good. <a href="https://www.wsj.com/articles/ruling-is-latest-salvo-in-trump-v-obamacare-1521115200">Now read this (via Stephanie Armour of the Wall St. Journal):</a></p>
<blockquote><p>Health insurers and the Trump administration face<strong> a court decision shortly that will determine whether the government must pay insurers billions of dollars despite Republican efforts to block payments they view as an industry bailout.</strong></p>
<p>Insurers have filed roughly <strong>two-dozen lawsuits claiming the federal government reneged on promises it made to pay them</strong> under the Affordable Care Act.</p>
<p>...It could also shape the outcome of other insurer lawsuits <strong>that would leave the government potentially owing as much as roughly $20 billion in past and future payments.</strong> Those cases, legal experts say, amount to <strong>the largest civil lawsuits ever.</strong></p>
<p><strong>More than money is at stake, however</strong>. If the federal government loses the lawsuits, the <strong>Trump administration could find itself forced to financially support a health law it has been seeking vigorously to undo.</strong></p>
<p>...<strong><span style="background-color:#ffff00">The standoff focuses partly on a program known as “risk corridors” that sought to entice insurers into the ACA markets by helping cover their financial risk.</span></strong></p>
<p>...Insurers say the administration promised to cover certain losses even if it didn’t collect enough from participating insurers. But <strong>Republicans have put provisions in the federal budget saying the program can only pay out as much as it collected, <span style="background-color:#ffff00">creating a shortfall for insurers that totaled about $12.3 billion.</span></strong></p>
<p>Insurers also say <strong>the administration reneged on “cost-sharing reduction” payments</strong> to be provided through a separate ACA program. The health law required insurers on the exchanges to offer subsidies to some low-cost consumers, and the insurers say the Obama administration promised to cover the subsidies’ costs.</p>
<p>...<strong>Insurers lost out on about $2 billion last year,</strong> and they would have gotten about $8 billion this year. Some are suing for both back payments and those that had been expected this year.</p>
</blockquote>
<p>That's where the $20 billion figure comes from--$12.3 billion of it is the Risk Corridor Payments which the carriers were stiffed out of, $2 billion is from the past-due Cost Sharing Reduction reimbursements from the fourth quarter of <strong>last</strong> year (remember, Trump pulled the plug in September 2017, cutting off payments for October, November and December), and the remaining $8 billion is what the carriers <strong>should</strong> be owed for <strong>2018</strong>. To be honest, I'm pretty sure that no matter what the judges end up ruling overall, the $8 billion in 2018 CSR payments will <strong>not</strong> be granted. The vast majority of carriers have <a href="http://acasignups.net/17/11/01/and-im-done-final-2018-rate-hike-average-295-35ths-caused-directly-trump-sabotage">already jacked up their premiums by an extra 14% or so to cover their projected 2018 CSR losses</a>, so <strong>this would be double-dipping.</strong></p>
<p><strong>The other $14.3 billion, however, is absolutely owed to them</strong>...even though there's a slight snag in that as well:</p>
<blockquote><p><strong>...Some of the insurers in the other cases have gone out of businesses since filing the lawsuits</strong>, raising questions about <strong>who may get the funds if the government loses</strong>. And <strong>some of the claims have been sold to private investors</strong> who would now stand to get the money.</p>
</blockquote>
<p>There's another important point here: <strong>The "Full Faith &amp; Credit of the United States" is at risk:</strong></p>
<blockquote><p>If the administration wins, <strong>others may become leery of contracts with the federal government</strong>, fearing agreements <strong>may later be blocked by an opposing political party</strong>, legal experts said.</p>
<p>“When the federal government has made a promise to pay and doesn’t, how do you enforce it?” Mr. Bagley said. <strong>“It makes it harder for parties to trust the government.”</strong></p>
</blockquote>
<p>What's that? Donald Trump stiffing contractors who kept up their part of the bargain in good faith? Say it ain't so!</p>
<p>In all seriousness, I admit the headline is a bit misleading, since for the most part the $12.3 billion Risk Corridor portion of the lawsuit would have been paid out to the carriers <strong>without</strong> Rubio's stunt in 2014 anyway, so it's not necessarily costing the taxpayers $12.3B <strong>more</strong>. HOWEVER, the Massacre didn't exist in a vacuum--if the RC funding hadn't been cut off in 2015, at least a few of the carriers which went belly up (most of them were ACA-created Co-Ops) would still be in business today, while other carriers which took a bath but stayed in business wouldn't have decided to bail on the ACA exchanges in various states, and so on.</p>
<p>Put another way: If the carriers hadn't been stiffed out of billions at the time, the odds are <strong>very</strong> good that overall losses would have been much lower in 2015 and 2016...which means instead of $12.3 billion being owed, it likely would've been quite a bit less (perhaps $5-$6 billion)? We'll never know now, of course.</p>
<p>In other words, the Risk Corridor Massacre caused a chain reaction of #FAIL: A dozen-plus smaller carriers went out of business and others dropped out of the market, which in turn reduced competition, which in turn led to a worse risk pool and higher premiums, which in turn led to more carriers dropping out the following year and so on.</p>
<p>I'm not saying that this was the <strong>only</strong> factor which caused those things to happen, but it sure as hell played a major role.</p>
<p>It also, as I noted in the link at the top of this entry, put several hundred people out of work and kicked 800,000 people off their healthcare policies at the end of 2015.</p>
<p>As David Anderson (aka "Richard Mayhew") put it at the time:</p>
<blockquote><p>...So the Rubio rider <strong>causes a lot of chaos</strong>, <strong>does not actually solve the problem</strong> it is superficially intended to solve, <strong>costs the government more money in the short term </strong>as the benchmarks are recalculated upwards, and <strong>costs the government more money in the long term </strong>as there are fewer insurers and thus less competition. The big winners are Rubio (as he gets to fundraise and preen off of it) and incumbent insurers that have large cash reserves.</p>
<p>Brilliant!</p>
</blockquote>
<p>The ultimate irony is that the main reason Rubio went through the trouble of doing all of this was to help suck up to GOP primary voters for his impending 2016 Presidential race...which he failed miserably at anyway.</p>
<p>Which means he literally did it for nothing at all.</p>
</div></div></div><div class="field field-name-field-tags field-type-taxonomy-term-reference field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/tags/risk-corridor-massacre">Risk Corridor Massacre</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_3">
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</ul>Fri, 16 Mar 2018 14:52:04 +0000Charles Gaba4910 at http://acasignups.nethttp://acasignups.net/18/03/16/revenge-rubio-con-marco-rubios-risk-corridor-massacre-could-cost-taxpayers-123-billion#commentsThought the politics of the Hyde Amendment couldn't get dumber? Guess again.http://acasignups.net/18/03/15/thought-politics-hyde-amendment-couldnt-get-dumber-guess-again
<span class="submitted-by">Thu, 03/15/2018 - 2:57pm</span><div class="field field-name-field-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="http://acasignups.net/sites/default/files/styles/400x400/public/jeckyll_hyde.jpg?itok=0rWDhZNl" width="220" height="282" alt="" /></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p><a href="http://acasignups.net/18/03/14/gop-fretting-over-whether-they-hate-abortion-more-they-love-saving-their-own-skins">Yesterday I noted that the GOP is attempting to tack on additional "abortion restriction" language</a> into the proposed ACA stabilization portion of the "must-pass" Omnibus Spending Bill set to be voted on next week. However, the actual wording of the "abortion language" was left a bit vague:</p>
<blockquote><p>Between the lines: <strong>This doesn't solve the partisan dispute over abortion language, as it'd bar plans that offer abortion coverage from receiving federal subsidies.</strong> But it hints that there's Republican support behind a set of policy changes that could substantially lower premiums ahead of the 2018 elections.</p>
</blockquote>
<p>I wrote an extensive piece about the way abortion coverage is <strong>currently</strong> handled for ACA exchange policies <a href="http://acasignups.net/17/10/08/absurdity-hyde-amendment-some-back-envelope-math">back in October 2017:</a></p>
<blockquote><p class="rteindent1">The ACA allows the coverage of abortion services through the marketplaces but includes a number of restrictions and requirements that insurers must follow before covering non-Hyde abortions. Many, though not all, of these restrictions are outlined in Section 1303 of the ACA, which includes specific rules related to the coverage of abortion services by QHPs and has been the subject of previous litigation. In particular, Section 1303:</p>
<ul><li><strong>Prohibits insurers from using any portion of premium tax credits or cost-sharing reduction payments to pay for non-Hyde abortion services;</strong></li>
<li>Requires insurers to inform consumers in their summary of benefits and coverage that the QHP they are considering includes coverage of non-Hyde abortion services; and</li>
<li><strong>Requires insurers that cover non-Hyde abortions to determine the cost of and then separately collect and segregate funds for non-Hyde abortion services.</strong></li>
</ul><p class="rteindent1">Section 1303 further specifies that individuals who purchase insurance that covers abortions must pay at least one dollar into a separate account specifically designated for abortion. These segregated accounts are designed to help ensure that the accounts are 1) funded solely by the enrollee’s premium (rather than by the premium tax credit) and 2) used exclusively to fund non-Hyde abortion services. Section 1303 also allows states to ban the coverage of abortions by QHPs sold through the marketplaces: to date, twenty-six states have done so. In an additional six states, no marketplace plans offered coverage for abortion during the 2016 plan year. Two states—California and New York—require health plans to cover abortions, subject to an exception for multistate plans, at least one of which in each state must offer insurance without abortion coverage.</p>
<p class="rteindent1">The actual wording of Section 1303 clarifies that<strong> the "separate account" payment has to be at least $1.00 per month per enrollee</strong></p>
<p>As I noted at the time, due to the absurdly ham-handed and convoluted hoops that insurance carriers have to jump through in order to offer abortion coverage on their exchange plans now, the end result is that <strong>there's likely a good $70 million or so just sitting around gathering interest in "abortion funds"</strong> around the country for no reason whatsoever, instead of being used to keep premiums a bit lower or whatever.</p>
<p>Well, the GOP has apparently come up with their own simple solution to this situation: <strong>They want to make it illegal for any exchange plan to offer abortion services at all, since all exchange plans have to offer APTC tax credits.</strong></p>
<p>I should note that in addition to the other obivous problems with this, it would also open up a huge can of legal worms, since:</p>
<p class="rteindent1"><strong>California and New York have required all ACA exchange policies to cover abortion for years, and Oregon recently passed a similar law.</strong> It's also my understanding that while Massachusetts doesn't legally require it, the insurance dept. and state exchange strongly encourage carriers to do so.</p>
</blockquote>
<p dir="ltr">Let's say that a given plan from a given policy has 10,000 people enrolled in it.</p>
<p dir="ltr">Right now, all 10,000 of them (whether male or female, whether of child-bearing age or not) have $1 per month of their premiums extracted, separated out and deposited into a special "Abortion Fund". That's $120,000 per year. As I number-crunched last October, around 2,400 of them would likely be women of child-bearing age, and of those, only around 45 likely actually had an abortion performed. At an average full-price cost of around $500 per abortion, assuming the carrier covers around 70% of the cost, that's around $16,000 actually spent on abortion claims, with the other $104,000 just...sitting...in...the...fund.</p>
<p dir="ltr">As stupid as that is today, I found out some more details about what exactly this new proposed "abortion language" actually is, and <a href="https://www.politico.com/story/2018/03/15/support-for-obamacare-stabilization-grows-but-abortion-language-unresolved-417686">it's just as stupid and insulting as I figured it would be:</a></p>
<blockquote><p><strong>Republicans want to prohibit any Obamacare stabilization funds from going toward coverage of abortion</strong> except in cases of rape, incest and if the woman’s life is in danger — and there is <strong>some dispute over how exactly the restrictions would be worded</strong>. Democrats are vowing to <strong>oppose any bill that imposes new abortion limitations.</strong></p>
<p>...Still, among the Republicans and Democrats who support Obamacare stabilization,<strong> the key dispute is over the abortion policy.</strong></p>
<p>Obamacare did not contain "Hyde" language — the prohibition on the federal funding of abortion named for its author, former Rep. Henry Hyde, that has been in every health spending bill since the mid-1970s. But Hyde language is a part of nearly every other federal health program, including Medicaid and the Children’s Health Insurance Program, a factor that has Republicans confident Democrats will acquiesce in the name of helping the health care law’s markets.</p>
<p>...Obamacare plans are allowed to cover abortion, <strong>but the law let states opt to prohibit abortion coverage in the plans offered in their states.</strong> As a result, <strong>26 states enacted some kind of restriction, whether a flat out prohibition or limitations on when it can be covered</strong>, according to the Guttmacher Institute, a research organization that supports abortion rights. <strong>Eleven states restrict abortion in any insurance plans written in their states. </strong></p>
</blockquote>
<p>I asked Politco reporter Jennifer Haberkorn about this, and she clarified:</p>
<blockquote><p dir="ltr">Correct, but <strong>it is not Hyde. GOP wants it.</strong> Dems argue that <strong>Hyde language could prohibit a state from using the stabilization funding if its risk pool includes a policy that covers abortion</strong>. <a href="https://t.co/VUhk75Q9vF">https://t.co/VUhk75Q9vF</a></p>
<p>— Jennifer Haberkorn (@jenhab) <a href="https://twitter.com/jenhab/status/974335784353443841?ref_src=twsrc%5Etfw">March 15, 2018</a></p></blockquote>
<p dir="ltr">In other words...</p>
<blockquote><p dir="ltr">Oh for God’s sake…OK, <strong>so now they’re saying that if 1 person is enrolled in 1 policy which covers abortion—even if no one actually HAS an abortion and if they did it would have to be paid for via separate fund anyway—that any reinsurance $ going towards that policy “counts”???</strong></p>
<p dir="ltr">— (((Charles Globalist-a))) (@charles_gaba) <a href="https://twitter.com/charles_gaba/status/974336343684866049?ref_src=twsrc%5Etfw">March 15, 2018</a></p>
</blockquote>
<p dir="ltr">Yes, that's right: Reinsurance funding is used to cover the bulk of the medical expenses of high-cost enrollees. Let's say the carrier has 50,000 enrollees total (10,000 in the policy described above, 40,000 in other policies. Let's say that 5% of those enrollees (around 2,500 of them) are high-expense enough to trigger reinsurance payments. Proportionately, around 500 of them will likely be enrolled in the "abortion plan". Of those, around 120 are likely women of child-bearing age...and of those, perhaps 2-3 <strong>might</strong> have an abortion at some point during the year (I don't imagine that a lot of people undergoing chemotherapy or whatever are likely to be having unprotected sex, but who am I to judge...plus, I suppose it could be the other way around: Perhaps the reason their medical expenses are so high is <strong>because</strong> they're having a troubled pregnancy...although in that case, I would imagine the "woman's life is in danger" factor would be triggered anyway).</p>
<p dir="ltr">Anyway...the GOP is arguing that because <strong>some</strong> of the reinsurance money <strong>might</strong> end up helping to cover a <strong>portion</strong> of the medical care for someone enrolled in a policy which <strong>happens</strong> to include abortion services--<strong>even if none of the enrollees actually became pregnant, much less had an abortion performed</strong>--that somehow this "counts" as "federal funds being used to pay for abortions".</p>
<p dir="ltr">Which is simply...nuts.</p>
<p dir="ltr">Oh, yeah, one more thing:</p>
<blockquote><p dir="ltr"><strong>Also, would prohibit CSR payments to insurance plans that include coverage of abortions.</strong></p>
<p>— Jennifer Haberkorn (@jenhab) <a href="https://twitter.com/jenhab/status/974338122162081793?ref_src=twsrc%5Etfw">March 15, 2018</a></p></blockquote>
<p dir="ltr">Shoot me now. Again, both of these provisons, just like the existing language, are <strong>specifically intended</strong> to make it such a <strong>royal pain in the ass for insurance companies to comply</strong> with the absurd hoops they have to jump through that none of them will bother even trying...which would, as the Democrats have rightly noted, effectively wipe out <strong>any</strong> abortion coverage for <strong>any</strong> woman in the individual market.</p>
<p dir="ltr">Of course, as I noted above, this would also cause a hell of a legal problem in states like California, New York and Oregon which legally <strong>require</strong> indy policies to cover abortion...</p>
</div></div></div><div class="field field-name-field-tags field-type-taxonomy-term-reference field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/tags/hyde-amendment">Hyde Amendment</a></div><div class="field-item odd"><a href="/tags/omnibus">Omnibus</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_4">
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</ul>Thu, 15 Mar 2018 18:57:37 +0000Charles Gaba4909 at http://acasignups.nethttp://acasignups.net/18/03/15/thought-politics-hyde-amendment-couldnt-get-dumber-guess-again#commentsBALL OF CONFUSION: Dems may have two more factors to consider re. the Omnibus Billhttp://acasignups.net/18/03/16/ball-confusion-dems-may-have-two-more-factors-consider-re-omnibus-bill
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<p>Yesterday I came out <strong>against</strong> the pending ACA stability package because one of the 5 proposed provisions should be a flat-out dealbreaker for Democrats (the abortion ban), while another one is would hurt more people than it helps (CSR funding).</p>
<p>Today, I need to explain the problem with CSR funding in a bit more detail but to <strong>also</strong> note a <strong>new</strong> twist which makes it even more complicated...as well as taking note of a <strong>sixth</strong> provision being thrown into the mix by the GOP which, again, should be a dealbreaker for Democrats.</p>
<p><strong>First up: CSR funding.</strong></p>
<p>I'm on the record as being <a href="http://acasignups.net/18/03/13/update-house-democrats-formally-introduce-aca-20">strongly in favor of a bill recently proposed by House Democrats</a> Frank Pallone, Jr., Richard Neal and Bobby Scott which would repair, strengthen and expand the ACA in a half-dozen ways while also preventing or reversing another half-dozen types of sabotage of the ACA by the Trump Administration. Here's the full list of what would be included in what I've shorthanded "<strong>ACA 2.0</strong>":</p>
<ol><li>Remove the 400% Federal Poverty Line (FPL) Advance Premium Tax Credit (APTC) cap for exchange enrollees</li>
<li>Beef up the APTC formula for ALL eligible enrollees, regardless of income</li>
<li><strong>Formally appropriate Cost Sharing Reduction (CSR) reimbursement payments</strong></li>
<li>Raise the CSR eligibility cap from 250% FPL to 400% FPL</li>
<li>Beef up the CSR formula for ALL eligible enrollees</li>
<li>Fix the ACA's "Family Glitch"</li>
<li>Codify restrictions on short-term plans to prevent Trump's #ShortAssPlans EO from using them to sabotage ACA plans</li>
<li>Codify restrictions on "association plans" to prevent Trump's #ShortAssPlans EO from using them to sabotage ACA plans</li>
<li>Strengthen protections of mandatory Essential Health Benefits (EHBs) across all plans</li>
<li>Limit "Silver Spamming" by codifying "Standardized Plans" into the ACA exchanges</li>
<li>Require HHS to fully fund the Open Enrollment Navigator/Outreach program</li>
<li>Require HHS to fully fund the Open Enrollment Advertising/Marketing program</li>
<li>Implement a robust federal Reinsurance program</li>
<li>Require HHS to fully fund the State Innovation program</li>
<li>Reopen funding for states which decide they want to create their own ACA exchange</li>
<li>Require full transparency of the HHS/Healthcare.Gov budget/spending decisions</li>
</ol><p>Every one of the above is a good, solid, important improvement to the Affordable Care Act...with <strong>one partial exception</strong>, highlighted above.</p>
<p>As I've explained many, many times, while appropriating CSR payments <strong>would</strong> help lower unsubsidized premiums for millions of people earning <strong>more</strong> than 400% FPL, <strong>it would also effectively RAISE premiums </strong>for millions of people earning <strong>LESS</strong> than 400% FPL.</p>
<p>Why? Because last fall a bunch of insurance carriers, state regulators and state-based exchanges got together and came up with <a href="http://acasignups.net/17/11/03/four-sons-csr-loading-how-millions-can-save-thousands-silver-load-silver-switcharoo-states">a clever workaround for the CSR payments being cut off, called "Silver Loading" or "Silver Switching"</a> depending on how they did it. The end result is that <a href="http://acasignups.net/17/08/24/how-will-csr-brouhaha-affect-you-its-complicated">this is how ACA premiums changed depending on the enrollee's income:</a></p>
<p class="rtecenter"><a class="colorbox colorbox-insert-image" href="http://acasignups.net/sites/default/files/styles/inline_default/public/csr_load_schemes.jpg?itok=tqgbfv1G"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/csr_load_schemes.jpg?itok=tqgbfv1G" /></a></p>
<p>I know it's complicated, but the bottom line is that <a href="https://www.axios.com/winners-and-losers-under-the-aca-market-stabilization-ill-1516912820-703db250-7bd1-4869-a941-2966416ebb85.html">around 3.3 million people in the 39 states covered by HealthCare.Gov alone</a> would see their net premiums <strong>increase</strong>, or around 36% of exchange enrollees. The percentage should be even higher for those in using the 12 state-based exchanges, since most of those went the "Silver Switch" route...I'd guess <strong>at least</strong> another 1.2 million, for a total of <strong>around 4.5 million people who'd see their premiums increase if CSRs are appropriated.</strong></p>
<p>OK, so who would actually be <strong>helped</strong> by CSRs being funded? Well, on the exchange itself this would only be around 900,000 people (Axios tags it at 683K across the 39 states on HC.gov), but there's also the entire <strong>off-exchange ACA-compliant individual market</strong> to consider. All told this is around 4 million people or so, but not all of them are in plans which would be impacted by CSR funding one way or the other. I don't know what the breakout is, but I'd imagine perhaps half of them would benefit...let's call it another 2.1 million, for <strong>around 3 million total.</strong></p>
<p>In other words, <strong>WITH SILVER LOADING/SILVER SWITCHING IN PLACE</strong>, appropriating CSR funding <strong>now</strong> would effectively <strong>hurt</strong> around 4.5 million l<strong>ower-income</strong> people while <strong>helping</strong> around 3 million <strong>middle-class</strong> people. This puts both Republicans (who unintentionally helped create this scenario in the first place) <strong>and</strong> Democrats in awkward positions about what the Right Thing To Do is...but also on how to frame/pitch their decision.</p>
<p>For instance: The "ACA 2.0" bill proposed by Democrats <strong>does</strong> include CSR funding...<strong>but it also includes beefing up the subsidy formula and extending subsidies to those earning &gt;400% FPL</strong>. That's a critical detail. Beefing up the subsidy cancels out the downside of funding CSRs while maintaining the upside.</p>
<p>Since the GOP's proposed Omnibus deal <strong>doesn't</strong> include improving the subsidy formula or removing the cap, it becomes a net negative for Democrats.</p>
<p>In addition, funding CSRs <strong>now</strong> after yanking them away for a full year would cause further confusion and turmoil when Open Enrollment comes around, as millions of people shop around and are shocked to see their subsidies suddenly plummet and their net costs <strong>increase</strong> at the same time the headlines are claiming premiums have <strong>decreased</strong>.</p>
<p>HOWEVER, there's <strong>another</strong> twist to this mess which I completely forgot about: <strong><span style="background-color:#ffff00">It's also possible that Silver Loading won't be allowed next year</span></strong><span style="background-color:#ffff00">.</span></p>
<p>It's my understanding that it's <strong>possible</strong> CMS <strong>may</strong> have the legal authority to forbid insurance carriers from utilizing the Silver Load/Silver Switch workaround going forward--that is, it could prove to be a one-time thing which gets nipped in the bud.</p>
<p>If so, and if CMS does indeed yank the rug out from under Silver Loading, the "more harm than good" argument would become moot.</p>
<p>In that scenario, the upside of <strong>not</strong> funding CSRs would pretty much disappear, leaving only the down side. Again, this is a very tricky, complicated situation, and the water just keeps getting muddier, but it's something that Dems will have to take into consideration.</p>
<p><a href="https://www.washingtonexaminer.com/policy/healthcare/gop-white-house-want-bill-on-short-term-health-plans-added-to-spending-deal">THAT BRINGS ME TO THE OTHER NEW TWIST:</a></p>
<blockquote><p><strong>GOP, White House want bill on short-term health plans added to spending deal</strong></p>
<p>Congressional Republicans and the White House want to add a bill that would expand access to cheap, low-quality healthcare plans to a long-term spending deal.</p>
<p>The bill from Sen. John Barrasso, R-Wyo., <strong>would expand the duration of short-term insurance plans</strong>, which would compete with Obamacare plans. The bill would <strong>build on the Trump administration's regulatory move to expand the plans.</strong></p>
<p><strong>...Barrasso's legislation builds on a proposed regulation that the Trump administration released this year. The proposed rule would expand the duration of short-term plans from 90 days to 364 days.</strong></p>
<p><strong>The legislation would do the same thing, but it would make the plans “guaranteed renewable” </strong>if the applicant wants, according to a statement on the bill.</p>
</blockquote>
<p>I previously labelled this bill, officially titled the "Improving Choices in Health Care Coverage Act", or ICHCCA, #IckyJunkPlan.</p>
<p>Note that if included, this would be the <strong>polar opposite</strong> of #7 on my list above ("Codify restrictions on short-term plans").</p>
<p><strong>The Barrasso bill should be treated by Democrats as a deal-breaker just as the Abortion Language provision.</strong></p>
<p>I'm sure there will be more nonsense as the clock keeps ticking, but here's where things stand as of this morning:</p>
<ul><li><strong><span style="background-color:#32cd32">Reinsurance: GOOD!</span></strong></li>
<li><em><span style="background-color:#ffff00">Copper Plans: (meh)</span></em></li>
<li><em><span style="background-color:#ffff00">Waiver Flexibility: (meh)</span></em></li>
<li><em><span style="background-color:#cceaee">CSR Funding (with Silver Loading allowed): (NET NEGATIVE)</span></em></li>
<li><em><span style="background-color:#ffff00">CSR Funding (with Silver Loading prohibited): (it's complicated)</span></em></li>
<li><span style="background-color:#cceaee">Abortion Prohibition: <strong>DEAL-BREAKER</strong></span></li>
<li><span style="background-color:#cceaee">ShortAssPlan Expansion: <strong>DEAL-BREAKER</strong></span></li>
</ul><p>Put another way, the only <strong>clearly</strong> positive item on this list is the $10 billion/year in reinsurance funding. Two are simply unacceptable. Two are sort of neutral depending on your POV, and one (CSR funding) is just a mess at this point.</p>
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</ul>Thu, 15 Mar 2018 14:40:15 +0000Charles Gaba4908 at http://acasignups.nethttp://acasignups.net/18/03/16/ball-confusion-dems-may-have-two-more-factors-consider-re-omnibus-bill#commentsColorado: EXCITING NEWS! C4HCO overhauls...um...eligibility systemhttp://acasignups.net/18/03/14/colorado-exciting-news-c4hco-overhaulsumeligibility-system
<span class="submitted-by">Wed, 03/14/2018 - 4:56pm</span><div class="field field-name-field-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="http://acasignups.net/sites/default/files/styles/400x400/public/colorado_grey_10.png?itok=ki4x_bmI" width="300" height="300" alt="" /></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p>As long as I'm snarking on Washington's exchange for getting so excited over what appear to be pretty minor tweaks (to the average Joe, anyway), I might as well also give a shout-out to Connect for Health Colorado as well, <a href="http://connectforhealthco.com/important-step-forward/">which just posted this tidbit</a>:</p>
<blockquote><p>To Our Valued Stakeholders,</p>
<p>We took an important step forward this week with our board’s decision to <strong>move ahead on building a new eligibility system</strong>. With our own system, we will be able to provide customers<strong> a better application and enrollment experience</strong> and at the same gain <strong>more control and predictability for IT expenses.</strong></p>
<p><strong>A simplified path for enrolling with financial help</strong> can be expected to help us grow enrollment while <strong>getting more Coloradans the Advance Premium Tax Credit and Cost Share Reduction benefits</strong> that they are eligible to receive. We will continue to support Health First Colorado (Medicaid) enrollments and ensure that customers are routed to the right program, whether they begin at our site or with the PEAK application.</p>
<p><strong>The new system will be in place for our next Open Enrollment Period</strong>. Learn more details about our plan.</p>
<p>We will be providing regular updates and taking stakeholder input as we progress.</p>
</blockquote>
<p>In all seriousness, seemingly "minor", dry improvements/tweaks during the off-season can make a <strong>big</strong> difference when it's time to actually enroll. Glad to hear the exchanges are already plugging ahead, preparing for the sure-to-be-insane 6th Open Enrollment Period.</p>
<p>I don't know much about how C4HCO's technical platform operates, but they provide some simulation screen shots to give an idea of how the website screens will look when it's updated...this presumably will mean more to Colorado residents than me, of course:</p>
<p class="rtecenter"><a class="colorbox colorbox-insert-image" href="http://acasignups.net/sites/default/files/styles/inline_default/public/SafariScreenSnapz108.jpg?itok=_VBqqAyI"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/SafariScreenSnapz108.jpg?itok=_VBqqAyI" /></a></p>
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</ul>Wed, 14 Mar 2018 20:56:46 +0000Charles Gaba4907 at http://acasignups.nethttp://acasignups.net/18/03/14/colorado-exciting-news-c4hco-overhaulsumeligibility-system#commentsGOP fretting over whether they hate abortion more than they love saving their own skins.http://acasignups.net/18/03/14/gop-fretting-over-whether-they-hate-abortion-more-they-love-saving-their-own-skins
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<p><a href="https://www.axios.com/exclusive-alexanders-aca-market-stabilization-proposal-1521048225-a29f5027-9356-46e9-ac59-3859d4d47a69.html">via Caitlin Owens of Axios...</a></p>
<blockquote><p>Sens. Lamar Alexander and Susan Collins have proposed a market stabilization package that would include<strong> funding for the Affordable Care Act's cost-sharing reduction subsidies for three years, three years of federal reinsurance at $10 billion a year, additional ACA waiver flexibility for states, and expanded eligibility for "copper" plans.</strong></p>
<p>Alexander presented the plan yesterday to America's Health Insurance Plan's board of directors, adding that if Democratic leadership supports the bill, “it’ll be law by the end of next week." Alexander has long said the package should be <strong>included on the omnibus spending bill.</strong></p>
<p><strong>Between the lines:</strong> This doesn't solve the <strong><span style="background-color:#ffff00">partisan dispute over abortion language,</span></strong> as it'd <strong><span style="background-color:#ffff00">bar plans that offer abortion coverage from receiving federal subsidies</span></strong>. But it hints that there's Republican support behind a set of policy changes that could substantially lower premiums ahead of the 2018 elections.</p>
</blockquote>
<p>This news mostly confirms that the proposal which <a href="http://acasignups.net/18/03/13/breaking-news-adding-more-funding-aca-policies-will-lower-premiums-bunch-cover-millions">Oliver Wyman's projection analysis from the other day referred to is legit:</a></p>
<blockquote><p>More recent congressional attention is focusing on a proposal that includes <strong>an extension of CSRs and a reinsurance program in 2019, 2020, and 2021, funded with a $10 billion appropriation in each year</strong>, with a federal fallback option available to states in 2019. The federal fallback option would likely be based on – and use the federal infrastructure built to administer – the Transitional Reinsurance Program in place from 2014 through 2016.</p>
</blockquote>
<p>Owens doesn't clarify whether those are the <strong>only</strong> elements of the proposed Omnibus deal, but if so, it's an updated/blended version of the previous Alexander-Murray &amp; Collins-Nelson bills, and would include:</p>
<ul><li><strong>1. Three years of CSR reimbursement funding</strong> appropriation (I assume they'd tack on the money still owed to the carriers from Q4 2017 as well)</li>
<li><strong>2. Three years of reinsurance funding at $10 billion per year</strong></li>
<li><strong>3. "Copper Plans" being made available to anyone on the ACA exchange</strong> (presumably this would just remove the under-30 age cap on "Catastrophic" plans)</li>
<li><strong>4. Waiver "flexibility"</strong> (WARNING--this could be a good thing or a bad thing depending on the specifics!)</li>
</ul><p>And of course, the piece of poo floating in the pool...</p>
<ul><li><strong>5. Barring abortion coverage from any exchange policy, period</strong></li>
</ul><p>#4 ("waiver flexibility") might be harmless or harmful; I can't draw any conclusions about it without knowing specifics.</p>
<p><a href="http://acasignups.net/18/03/13/breaking-news-adding-more-funding-aca-policies-will-lower-premiums-bunch-cover-millions">#2 ($10B in reinsurance per year) would be a very good thing, as I noted the other day.</a></p>
<p><a href="http://acasignups.net/17/10/18/update-my-initial-thoughts-murrayalexander-csr-deal">Here's what I wrote about #3 (Copper Plans Available for All!) last fall:</a></p>
<blockquote><p>I presume the idea here would be to expand/rebrand Catastrophic plans as "Copper Plans" to everyone. It may or may not allow APTC subsidies to be applied towards them, but even if they aren't, the plans are dirt cheap to begin with. Personally, I think these are a lousy choice for most people, <strong>but if the choice is between them getting one of these plans or going off-exchange to a "short-term plan" or some other "mini-med"</strong> (aka a junk plan which doesn't include the same EHBs or which allow people with pre-existing conditions to be discriminated against), <strong>then this is still much better for one important reason: The Single Risk Pool.</strong></p>
<p>Currently, as Washington State actuary Rebecca Stob explained to me, <strong>one of the reasons why Catastrophic plans are so dirt cheap is because they're on their own, separate risk pool</strong> (at least for purposes of Risk Adjustment...I'm a little fuzzy on the distinction between that and Price Indexing).</p>
<p>...This is vitally important, because it means that one of two things happens: Either a lot of people go for Copper...or hardly anyone does.</p>
<p><strong>If very few do, it's no skin off of anyone's nose, and it becomes a meaningless concession</strong>. If a lot of people do, well, they'll probably have made a poor choice in most cases...<strong>but they'll still be part of the same risk pool,</strong> so they won't make it any worse for all the Bronze/Silver/Gold/Platinum folks. In fact, it<strong> might</strong> even have a net positive effect, by bringing in 1-2 million more of the very Young Invincible types that the exchanges have been starving for all along.</p>
</blockquote>
<p>In short, I'm sort of iffy on Copper Plans, but I'd be willing to live with them if necessary.</p>
<p>That leaves #1 (CSR funding) and #5 (abortion coverage).</p>
<p>As I've written about too many times to remember, I was <strong>in favor</strong> of funding CSR reimbursements for much of last year...but the moment that the carriers/exchanges/regulators came up with the Silver Load/Silver Switch workaround, I completely changed my tune. The CSR/premium/subsidy situation is completely turned around now, to the point that <strong><span style="background-color:#ffff00">funding CSRs NOW would actually hurt more people than it helps</span></strong>...<strong>at least without some other significant restructuring or enhancement of the subsidy formula, anyway.</strong></p>
<p>As Colin Baillio of Health Action New Mexico put it:</p>
<blockquote><p dir="ltr">Here’s what ending CSRs did for New Mexicans. Reinstating CSRs will raise costs for working families.</p>
<p dir="ltr"><a class="colorbox colorbox-insert-image" href="http://acasignups.net/sites/default/files/styles/inline_default/public/new_mexico_csrs.jpg?itok=7L9ZuetC"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/new_mexico_csrs.jpg?itok=7L9ZuetC" /></a></p>
<p>— Colin B (@colinb1123) <a href="https://twitter.com/colinb1123/status/973994254790881280?ref_src=twsrc%5Etfw">March 14, 2018</a></p></blockquote>
<p>Finally, there's the abortion language, which is just a big tired old crock of stupid for several reasons.</p>
<p><a href="http://acasignups.net/17/10/08/absurdity-hyde-amendment-some-back-envelope-math">Here's what I wrote about it back in October:</a></p>
<blockquote><p class="rteindent1">The ACA allows the coverage of abortion services through the marketplaces but includes a number of restrictions and requirements that insurers must follow before covering non-Hyde abortions. Many, though not all, of these restrictions are outlined in Section 1303 of the ACA, which includes specific rules related to the coverage of abortion services by QHPs and has been the subject of previous litigation. In particular, Section 1303:</p>
<ul><li><strong><span style="background-color:#ffff00">Prohibits insurers from using any portion of premium tax credits or cost-sharing reduction payments to pay for non-Hyde abortion services;</span></strong></li>
<li>Requires insurers to inform consumers in their summary of benefits and coverage that the QHP they are considering includes coverage of non-Hyde abortion services; and</li>
<li><strong><span style="background-color:#ffff00">Requires insurers that cover non-Hyde abortions to determine the cost of and then separately collect and segregate funds for non-Hyde abortion services.</span></strong></li>
</ul><p class="rteindent1">Section 1303 further specifies that individuals who purchase insurance that covers abortions must pay at least one dollar into a separate account specifically designated for abortion. These segregated accounts are designed to help ensure that the accounts are 1) funded solely by the enrollee’s premium (rather than by the premium tax credit) and 2) used exclusively to fund non-Hyde abortion services. Section 1303 also allows states to ban the coverage of abortions by QHPs sold through the marketplaces: to date, twenty-six states have done so. In an additional six states, no marketplace plans offered coverage for abortion during the 2016 plan year. Two states—California and New York—require health plans to cover abortions, subject to an exception for multistate plans, at least one of which in each state must offer insurance without abortion coverage.</p>
<p>The actual wording of Section 1303 clarifies that<strong> the "separate account" payment has to be at least $1.00 per month per enrollee:</strong></p>
<p class="rteindent1">(C) &lt;&lt;NOTE: Cost estimate.&gt;&gt; Actuarial value of optional service coverage.-- (i) In general.--The Secretary shall estimate the basic per enrollee, per month cost, determined on an average actuarial basis, for including coverage under a qualified health plan of the services described in paragraph (1)(B)(i). (ii) Considerations.--In making such estimate, the Secretary-- (I) may take into account the impact on overall costs of the inclusion of such coverage, but may not take into account any cost reduction estimated [[Page 124 STAT. 171]] to result from such services, including prenatal care, delivery, or postnatal care; (II) shall estimate such costs as if such coverage were included for the entire population covered; and (III) <strong>may not estimate such a cost at less than $1 per enrollee, per month.</strong></p>
</blockquote>
<p>As I noted at the time, due to the absurdly ham-handed and convoluted hoops that insurance carriers have to jump through in order to offer abortion coverage on their exchange plans <strong>now</strong>, the end result is that there's likely a good <strong>$70 million</strong> or so just sitting around gathering interest in "abortion funds" around the country for no reason whatsoever, instead of being used to keep premiums a bit lower or whatever.</p>
<p>Well, the GOP has apparently come up with their own simple solution to this situation: They want to make it <strong>illegal for any exchange plan to offer abortion services at all</strong>, since all exchange plans have to offer APTC tax credits.</p>
<p>I should note that in addition to the other obivous problems with this, it would also open up a<strong> huge can of legal worms, since:</strong></p>
<blockquote><p><strong>California and New York have required all ACA exchange policies to cover abortion for years, and Oregon recently passed a similar law</strong>. It's also my understanding that while Massachusetts doesn't legally require it, the insurance dept. and state exchange strongly encourage carriers to do so.</p>
</blockquote>
<p>It's possible that the Alexander-Collins plan would only apply to the federal exchange, which would cut CA and NY out of the loop as they both operate their own exchanges...but Oregon might be in a pickle, since they rely on HealthCare.Gov to run their platfom. Not sure about that.</p>
<p>Of course, regardless of whether this is limited to HC.gov or not, <strong>putting the kibosh on any abortion coverage being offered even if paid for directly by the enrollee</strong> should be <strong>completely unacceptable to Congressional Democrats, period</strong>...and judging by the developments the past week, that appears to be the case; good.</p>
<p>If that's removed from the equation, we're left with four items: CSRs, reinsurance, Copper plans and "waiver flexibility".</p>
<p>My take? <strong>Drop the Abortion &amp; CSR language, keep the Reinsurance, Copper Plans and Flexibility.</strong></p>
<p>$10 billion/year in reinsurance would substantially lower premiums for unsubsidized enrollees without raising the net cost for subsidized folks. Copper plans would at the very least scratch one of the attack points on the ACA exchanges off the list, while also making the policy types easier to explain ("Platinum/Gold/Silver/Bronze/Copper" is easier than "P/G/S/B...oh, and there's also these "Catastrophic only" plans which are only available if you're under 30..."). Making waivers flexible would...I dunno, make them more flexible, I guess.</p>
<p>Now, <strong>politically</strong>, it's probably in the Democrats best interest not to agree to <strong>any</strong> stabilization measures--a classic case of flipping the script on what the GOP did to the Obama Administration for 8 years by refusing to lift a finger to help improve the law. However, at least in the case of reinsurance, they'd be helping people without hurting anyone in the process.</p>
<p>Appropriating the CSR reimbursements <strong>at this point</strong>, however, would <strong>raise</strong> net costs for several million people, effectively cancelling out any good it did. For that matter, the only "good" it did would involve reversing the impact of the <strong>very sabotage of the law which the GOP themselves deliberately caused to happen in the first place</strong>.</p>
<p>This is the essence of chutzpah: Trump &amp; the GOP <a href="http://acasignups.net/17/11/01/and-im-done-final-2018-rate-hike-average-295-35ths-caused-directly-trump-sabotage">deliberately caused unsubsidized premiums to increase by a good 15%</a> by bringing the lawsuit and cutting off payments in the first place...then turn around a year later and <strong>appropriate the very funding they caused to be cut off</strong>, lowering unsubsidized premiums by 10% and claiming "SEE! WE LOWERED OBAMACARE PREMIUMS! VOTE FOR US!"</p>
<p>The Dems should walk away from this unless both the abortion &amp; CSR elements are removed.</p>
</div></div></div><div class="field field-name-field-tags field-type-taxonomy-term-reference field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/tags/csrs">CSRs</a></div><div class="field-item odd"><a href="/tags/abortion">Abortion</a></div><div class="field-item even"><a href="/tags/reinsurance">Reinsurance</a></div><div class="field-item odd"><a href="/tags/copper-plans">Copper Plans</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_7">
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</ul>Wed, 14 Mar 2018 18:08:05 +0000Charles Gaba4906 at http://acasignups.nethttp://acasignups.net/18/03/14/gop-fretting-over-whether-they-hate-abortion-more-they-love-saving-their-own-skins#commentsDEAR DEMOCRATS: PA18 makes it clear: Whether ACA2, MEFA or M4A, it's time to go on offense on healthcare.http://acasignups.net/18/03/14/dear-democrats-pa18-makes-it-clear-whether-aca2-mefa-or-m4a-its-time-go-offense-healthcare
<span class="submitted-by">Wed, 03/14/2018 - 11:22am</span><div class="field field-name-field-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="http://acasignups.net/sites/default/files/styles/400x400/public/ppp_logo.jpg?itok=ybQXgl2a" width="300" height="300" alt="" /></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p><a href="http://www.protectourcare.org/wp-content/uploads/2018/03/PA18PostElectionSurvey.pdf">From Public Policy Polling this morning:</a></p>
<blockquote><p><strong>Exit Poll of PA-18 Shows Lamb Won Big On Health Care</strong><br />
Date: March 14, 2018</p>
<p>Public Policy Polling conducted a telephone exit poll election survey of <strong>voters who cast ballots in Pennsylvania’s 18th Congressional District special election yesterday</strong>. Voters who voted in the contest were asked about <strong>the role of health care in their decision.</strong></p>
<p>The exit poll shows that h<strong>ealth care was a top priority issue to voters in this district </strong>and that <strong>voters believed Democrat Conor Lamb’s views were more in step with theirs.</strong></p>
<p>In 2016, <strong>voters in this district backed Donald Trump by 20 points</strong>, but <strong>last night they backed a Democrat for Congress </strong>in a referendum on the <strong>health care plans of the Republican Congress:</strong></p>
<ul><li><strong>Health care was a top issue to voters.</strong> Health care was ranked as a <strong>top issue for 52% of voters</strong> (15% saying it was the most important issue and another 37% saying it was very important). Only 19% said it was not that important or not important at all.</li>
</ul><ul><li><strong>Conor Lamb won big especially among voters for whom health care was a top priority.</strong> Among voters who said health care was the most important issue for them, <strong>Lamb beat Rick Saccone 64-36 </strong>and among the broader group of voters who said it was either the most important or a very important issue <strong>Lamb beat Saccone 62-38.</strong></li>
</ul><ul><li>On health care, voters said <strong>Lamb better reflected their views by 7 points </strong>(45% to 38%) over Saccone. <strong>With independents, that gap widened to 16 points</strong> with 50% saying Lamb’s health care views were more in line with theirs to only 34% for Saccone.</li>
</ul><ul><li>Voters were <strong>less likely to support Saccone because of the Republican health care agenda</strong>. Saccone’s support of the Republican health care agenda made <strong>41% of voters less likely to vote for him</strong> and only 28% more likely to support him.</li>
</ul><ul><li><strong>Voters in this heavily Republican district disapproved of the Republican efforts to repeal the Affordable Care Act by 14 points</strong> (53% to 39%).</li>
</ul><ul><li><strong>48% of voters believed Republicans are now trying to undermine and sabotage it</strong> since they failed to repeal it. Among <strong>independent voters,</strong> the disparity is even wider with only 33% supporting the GOP’s health care repeal efforts to <strong>63% opposing them.</strong></li>
</ul><ul><li><strong>In this deeply red district, 44% of voters support the Affordable Care Act while 42% oppose it.</strong></li>
</ul><ul><li>Only 38% of voters think the best path forward on health care is to repeal the Affordable Care Act, to <strong>59% who think it should be kept in place with fixes made to it as necessary.</strong></li>
</ul><p>PPP surveyed 567 PA-18 voters on March 13th. The margin of error is +/- 4.1%. This survey was a joint project of Protect Our Care and SEIU.</p>
</blockquote>
<p>Anyone who reads my site, listens to my presentations or watches my videos should already know this, but the path for 2018 and 2020 on healthcare for Democrats is clear:</p>
<ul><li><strong>2019: </strong><a href="http://acasignups.net/18/03/13/update-house-democrats-formally-introduce-aca-20">Pass the Undo Sabotage &amp; Expand Affordability of Health Insurance Act</a> IMMEDIATELY upon taking office in January 2019 (this assumes a big blue wave, of course).</li>
</ul><p>Since #USEAHIA is an absurdly stupid acronym/hashtag, I'm terming this bill <strong>ACA 2.0</strong> instead.</p>
<p>Before anyone says it: Yes, I realize this would probably be vetoed by Donald Trump; unless some miracle happens and we're blessed with President Pelosi, the odds are 99.9% that we're gonna be dealing with a President Trump or President Pence through January 20, 2021.</p>
<p>However, <strong>unlike a total overhaul bill</strong>, there's a <strong>small</strong> chance that Trump <strong>might</strong> sign such a bill if it's bundled as part of a "must-pass" omnibus/budget bill, the way he signed the 6-year (later 10-year) CHIP extension recently. Stranger things have happened.</p>
<p>If it becomes law, it will stabilize and strengthen the ACA for several years, tiding things over until...</p>
<ul><li><strong>2021</strong>: Assuming a Democratic sweep in 2020, pass <a href="http://acasignups.net/18/03/14/update-lets-dive-caps-medicare-extra-all">some variant of CAP's Medicare Extra for All (MEFA)</a>. It may look somewhat different than MEFA as presented last month, but it will likely look similar.</li>
</ul><p>Obviously this is where the real battle lines will be drawn on the left side of the aisle: Folks like myself will push for a CAP/MEFA-style system, while Bernie supporters will push hard for a full-blown, near-immediate M4A/SP bill. If there's a full Democratic sweep, the final version may end up somewhere in between the two.</p>
<p>Alternately, if for some reason 2021 brings a Democratic House/Senate but with a Republican President (which I can only envision if someone like John Kasich manages to "reform" the GOP after Trump is removed from office/etc), then the final bill that's passed will probably be somewhere in between ACA 2.0 and MEFA, I'd imagine...either of which would still be a quantum leap ahead of where things stand today.</p>
<p><strong>UPDATE:</strong> Here’s roughly how I envision the path of the Dems healthcare strategy under Obama, Trump and in the future:</p>
<ul><li>2010 — 2013: <strong>ACA 1.0</strong> (as passed)</li>
<li>2014 — 2016: <strong>ACA 0.9</strong> (weakened via tech screw-ups/other mistakes &amp; pre-Trump sabotage)</li>
<li>2017:<strong> ACA 0.8 </strong>(weakened further via 2017 Trump-era sabotage, such as CSR cut-off, half-length enrollment period, 90% marketing cuts, etc.)</li>
<li>2018: <strong>ACA 0.7</strong> (weakened further due to Trump’s 2018 sabotage, mainly Mandate Repeal, #ShortAssPlans &amp; Medicaid Work Requirements)</li>
<li>2019 — 2021: <strong>ACA 2.0 (assuming it can actually get signed)</strong></li>
<li>2022/beyond (assuming full Dem sweep): <strong>Some MEFA/M4A hybrid</strong></li>
<li>2022/beyond (assuming partial Dem wave): <strong>Some MEFA/ACA2.0 hybrid</strong></li>
</ul></div></div></div><div class="field field-name-field-tags field-type-taxonomy-term-reference field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/tags/mefa">MEFA</a></div><div class="field-item odd"><a href="/tags/aca2">ACA2</a></div><div class="field-item even"><a href="/tags/m4a">M4A</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_8">
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</ul>Wed, 14 Mar 2018 15:22:11 +0000Charles Gaba4905 at http://acasignups.nethttp://acasignups.net/18/03/14/dear-democrats-pa18-makes-it-clear-whether-aca2-mefa-or-m4a-its-time-go-offense-healthcare#commentsSen. Baldwin introduces bill to beef up ACA subsidies for Young Invincibleshttp://acasignups.net/18/03/14/sen-baldwin-introduces-bill-beef-aca-subsidies-young-invincibles
<span class="submitted-by">Wed, 03/14/2018 - 10:15am</span><div class="field field-name-field-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="http://acasignups.net/sites/default/files/styles/400x400/public/tammy_baldwin_0.jpg?itok=a9mVKRKb" width="294" height="300" alt="" /></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p>Wisconsin Senator Tammy Baldwin has been on a bit of an "Improve the ACA" tear lately. A couple of weeks ago she introduced the <a href="http://acasignups.net/18/03/05/sen-tammy-baldwin-introduces-bill-head-trumps-shortassplans-pass">"Fair Care Act"</a> to try and nip Donald Trump's #ShortAssPlans proposal in the bud. Now she's introduced another bill which would help shore up the ACA exchanges themselves: The <a href="https://www.washingtonexaminer.com/tammy-baldwin-introduces-bill-to-bring-more-young-people-into-obamacare">"Advancing Youth Enrollment Act"</a> via Kimberly Leonard of the Washington Examiner):</p>
<blockquote><p>The Advancing Youth Enrollment Act would give higher <strong>federal subsidies to people between the ages of 18-34</strong> so that the cost of private Obamacare plans for them would be lower.</p>
<p>...Under the proposal, young adults would see the <strong>maximum percentage of income they must pay toward health insurance under Obamacare decrease by 2.5 percentage points</strong> for people between the ages of <strong>18 to 30</strong>. Each year after, <strong>until the age of 34, they would see a gradual phaseout of 0.5 percentage points a year.</strong></p>
</blockquote>
<p>Here's what the ACA's Advance Premium Tax Credit (APTC) formula looks like today for everyone, and how it would look under Baldwin's bill specifically for those aged 18-30 only (you can fill in the blanks for the 31-34 phaseout):</p>
<p class="rtecenter"><a class="colorbox colorbox-insert-image" href="http://acasignups.net/sites/default/files/styles/inline_default/public/Microsoft%20ExcelScreenSnapz2059.jpg?itok=9oNWBEDA"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/Microsoft%20ExcelScreenSnapz2059.jpg?itok=9oNWBEDA" /></a></p>
<p>How much would this help shore up and improve the ACA individual market?</p>
<blockquote><p>An analysis by the pro-Obamacare group Young Invincibles projects that <strong>4 million people between the ages of 19 to 34 would be eligible for higher subsidies </strong>if the legislation passed. Nearly <strong>half a million</strong> could be able to have health insurance that would come with <strong>no deductible and with a premium of $23 a month or less</strong>, and <strong>300,000 people would have no premium at all.</strong></p>
<p>At this time, a <strong>typical young person with coverage from the Obamacare exchange</strong>, purchasing a mid-level silver plan, is paying <strong>about $150 a month</strong>. That same plan would be <strong>$95 under the Advancing Youth Enrollment Act.</strong></p>
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<p>I'd still prefer that they simply remove the 400% FPL cap altogether, but this is a reasonable idea as well. If it results in several million more Young Invincibles jumping into the ACA market, that would instantly improve the overall risk pool, which should result in lower full-price premiums for everyone regardless of income, so it's a sound idea.</p>
<p>Of course, I'm all for doing <strong>both</strong>, and <strong>neither</strong> is likely to happen until at least January 2019 anyway, so there you go...</p>
</div></div></div><div class="field field-name-field-tags field-type-taxonomy-term-reference field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/tags/young-invincibles">Young Invincibles</a></div><div class="field-item odd"><a href="/tags/tammy-baldwin">Tammy Baldwin</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_9">
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</ul>Wed, 14 Mar 2018 14:15:30 +0000Charles Gaba4904 at http://acasignups.nethttp://acasignups.net/18/03/14/sen-baldwin-introduces-bill-beef-aca-subsidies-young-invincibles#commentsWashington State: House Bill 2516 passes, helping the WA exchange...um...do stuff?http://acasignups.net/18/03/14/washington-state-house-bill-2516-passes-helping-wa-exchangeumdo-stuff
<span class="submitted-by">Tue, 03/13/2018 - 6:00pm</span><div class="field field-name-field-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="http://acasignups.net/sites/default/files/styles/400x400/public/washington_grey_13.png?itok=hBzRK5-8" width="300" height="300" alt="" /></div></div></div><div class="field field-name-field-video field-type-video-embed-field field-label-hidden"><div class="field-items"><div class="field-item even">
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<p>I honestly can't make heads or tails out of what, exactly, the just-passed HB2516 from the Washington State legislature actually <strong>does</strong>, but the <a href="https://www.wahbexchange.org/washington-health-benefit-exchange-issues-statement-house-bill-2516/">WA Health Benefit Exchange seems to be pretty happy about whatever it is:</a></p>
<blockquote><p>Today, Pam MacEwan, CEO of the Washington Health Benefit Exchange, issued the following statement on the signing of House Bill 2516: </p>
<p><strong>“The Washington Health Benefit Exchange applauds today’s signing of House Bill 2516 by Gov. Jay Inslee.</strong></p>
<p>“This state-level legislation <strong>protects important progress</strong> made in Washington state under the Affordable Care Act. Our position as the state’s health insurance gateway is now <strong>stronger than ever</strong>, and despite continued uncertainty we may see at the federal level, this bill <strong>enables us to continue improving the customer experience</strong> for the people in our state.</p>
<p>“The bill’s<strong> removal of outdated requirements</strong> that <strong>no longer align with our current operations </strong>clears the way for the Exchange to <strong>better serve all residents </strong>of Washington state. This includes language that will <strong>allow us to innovate and operate</strong> in ways that allow our customers to c<strong>onnect with and maintain their health coverage</strong>. These changes also <strong>create opportunities for maximizing the state’s investment in the Exchange’s technology</strong> to<strong> further improve</strong> how people seek and receive health and health-related benefits.</p>
<p>“We would like to thank both the Governor and the Washington state Legislature for their support on the passage of this legislation. Their combined efforts have resulted in a <strong>significant achievement for the future of the Exchange</strong> and how we deliver health coverage to more than 1.8 million residents of our state.”</p>
</blockquote>
<p>Well...good for them, then.</p>
<p><strong>UPDATE:</strong> Thanks to Twitter follower #80k_0k8 (yes, that's the handle) for the <a href="http://lawfilesext.leg.wa.gov/biennium/2017-18/Pdf/Bills/House%20Passed%20Legislature/2516-S.PL.pdf">link to the actual text</a>. It sounds like a lot of small nips &amp; tucks, including removing redundant language and/or no-longer-relevant deadlines "By December 15, 2011" and so forth. Fair enough.</p>
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</ul>Tue, 13 Mar 2018 22:00:36 +0000Charles Gaba4903 at http://acasignups.nethttp://acasignups.net/18/03/14/washington-state-house-bill-2516-passes-helping-wa-exchangeumdo-stuff#comments